Intrauterine Insemination (IUI) is often the first step for many couples on their fertility journey. It is a less invasive and more affordable procedure than IVF, but its success depends heavily on precise timing and ultrasound monitoring. At Talwar Fertility & Child Health Centre, we follow a meticulous protocol to ensure the best possible outcome.

Phase 1: The Baseline Scan (Day 2)

The journey begins on the 2nd day of your menses (D2). This initial ultrasound is critical to:

• Assess the Antral Follicular Count (AFC).
• Rule out any pre-existing ovarian cysts, such as follicular or corpus luteal cysts, that might interfere with the current cycle.

Phase 2: Ovulation Induction

If the baseline scan shows an endometrial thickness of less than 4 mm and no follicles larger than 6 mm, we proceed with Ovulation Induction. Medication (Clomiphene Citrate or Letrozole) is started on Day 2 or Day 3 for five days. Depending on the patient’s profile, Gonadotrophins may also be added.

Phase 3: Follicular Monitoring

Transvaginal Sonography (TVS) begins on the 9th day of menses (D9). We track the growth of the follicles every alternate day. The goal is to identify a “Dominant Follicle.”

Phase 4: The Trigger and Insemination

Once the dominant follicle reaches a mature size of 20-22 mm, we administer a “Trigger” injection of Human Chorionic Gonadotrophin (HCG) (5000/10000 IU). This mimics the body’s natural surge that causes the egg to be released.

Why Timing is Everything

At our Gurugram clinic, we emphasize that IUI success is a science of timing. By aligning the insemination exactly with the rupture of the follicle, we maximize the chances of fertilization. If you are planned for an IUI, following this schedule precisely is the most important thing you can do.

A baseline ultrasound of the ovaries is a critical step in assessing a woman’s reproductive health. It helps us evaluate the ovarian reserve, track the menstrual cycle, and screen for abnormalities. Here is what we look for in a normal, healthy ovary during a scan.

1. Anatomy and Volume

The ovaries are oval-shaped structures located on either side of the uterus within the ovarian fossa.

• Mean Volume: Approximately 4.9 ml is considered normal.
• Position: They usually lie near the internal iliac artery and vein, though their position can vary.

2. Antral Follicle Count (AFC)

The best time to evaluate the ovaries is on Day 2 or Day 3 of the menstrual cycle (Follicular Phase). During this time, we measure Antral follicles (small sacs containing immature eggs) ranging from 2-9 mm.

3. Ovulation and Color Doppler

In a natural cycle, one follicle becomes “dominant,” reaching a size of 17–24 mm before releasing the egg (ovum).

• Blood Flow: Normal stromal blood flow velocity is 6–12 cm/sec. Flow velocity typically increases just before and immediately after ovulation.
• Corpus Luteum: After the egg is released, the follicle transforms into the Corpus Luteum. On ultrasound, it appears as a round cystic mass with thick, echogenic walls.
• The “Ring of Fire”: On Power Doppler, the Corpus Luteum displays a characteristic “Ring of Fire” appearance due to highly increased blood flow around it.

In the world of fertility, an ultrasound is much more than just a picture; it is a vital diagnostic window. It helps us understand your reproductive health and tailor a treatment plan specifically for you.

How Is It Done? TAS vs. TVS

Depending on your comfort and medical requirement, we use two methods:

Timing: When Should You Have A Scan?

In fertility treatments, the timing of the scan is crucial. We usually monitor on three specific days of your cycle:

• Day 2 (D2): To check Antral Follicular Count (AFC). A normal count is 5-10 follicles in each ovary. This helps us predict how your body will respond to treatment and rules out old cysts.
• Day 9 (D9): To look for the Endometrial Lining. We look for a “triple-layer” pattern and use color Doppler to ensure healthy blood flow for embryo receptivity.
• Day 21 (D21): To confirm secretory changes in the lining, ensuring the environment is ready for a pregnancy.